Sleep disturbances in children and adolescents with epilepsy: Clinical, polysomnographic and management aspects

Abstract

Background: Sleep and epilepsy interact through bidirectional neurobiological mechanisms. In children, sleep disturbances are highly prevalent and may exacerbate seizures while adversely affecting cognition, behaviour, and quality of life.

Objective: To synthesise current evidence on sleep disturbances in paediatric epilepsy by integrating subjective reports and objective sleep measures across epilepsy severity, syndromes, and common neurodevelopmental comorbidities, and to discuss implications for clinical management.

Methods: Narrative review of studies assessing sleep in children and adolescents with epilepsy using validated questionnaires and objective tools, including polysomnography/video-EEG-polysomnography, actigraphy, and cyclic alternating pattern analysis. Evidence was summarised according to epilepsy severity, epilepsy syndrome, comorbid ADHD/ASD, caregiver outcomes, and management strategies.

Results: Questionnaire-based studies consistently report high rates of sleep problems and associations with behavioural difficulties and poorer cognitive performance. Objective evidence, including meta-analytic data, demonstrates reduced total sleep time, decreased sleep efficiency, increased sleep fragmentation, and altered sleep-stage distribution compared with healthy controls. Drug-resistant epilepsy shows a severity gradient characterised by marked macrostructural disruption (reduced N3 and REM sleep, increased wake after sleep onset) and microstructural NREM instability, particularly in children with cognitive impairment. Reported sleep alterations appear syndrome-specific and influenced by seizure burden, nocturnal epileptiform activity, and treatment-related factors. Sleep disruption is also prominent in epilepsy with neurodevelopmental comorbidities and is closely associated with caregiver sleep disturbance and mental health burden.

Conclusions: Sleep impairment in childhood epilepsy is common, clinically meaningful, and potentially modifiable. Systematic screening with validated tools and targeted objective assessment may support interventions that improve sleep quality, seizure-related outcomes, daytime functioning, and family well-being.

Keywords: Adolescents; Children; Insomnia; Polysomnography; Sleep disorders.